Journal of Endocrinological Investigation

, Volume 37, Issue 12, pp 1155–1164 | Cite as

Childhood obesity: prevention and strategies of intervention. A systematic review of school-based interventions in primary schools

  • A. VerrottiEmail author
  • L. Penta
  • L. Zenzeri
  • S. Agostinelli
  • P. De Feo



Two crucial aspects of obesity prevention are early childhood and school-based interventions. The main purpose of this systematic review wass to evaluate the efficacy and the feasibility of school-based interventions performed in primary schools.


All pertinent data from the literature have been critically examined and reviewed to evaluate the efficacy and the feasibility of different strategies of interventions. In particular, many studies have been performed in school-aged children.


Data from literature suggest that educational interventions toward healthy eating habits and physical activity at school could be a key strategy in the prevention of obesity, because it has been shown that is difficult to treat obesity in adults through changes in the lifestyle rather than during childhood. Recent advances in technology, especially web-based interventions, have been used to provide a specific content addressing healthy lifestyle with regard diet and exercise. These data suggest the opportunity to use web-interactive programs as a new challenging technique of communication in order to promote healthy behaviors.


The early detection and treatment of obesity in children may be the best approach to prevent future increases in morbidity, as well as healthcare costs that will likely occur as overweight and obese children age.


Obesity Prevention School-based Web-based Children 


Conflict of interest

No potential conflicts of interest relevant to this article have been reported.


  1. 1.
    WHO (2009) Population-Based Prevention Strategies for Childhood Obesity: report of a WHO forum and technical meeting.
  2. 2.
    Williams DP, Going SB, Lohman TG et al (1992) Body fatness and risk for elevated blood-pressure, total cholesterol, and serum-lipoprotein ratios in children and adolescents. Am J Public Health 82(3):358–363PubMedCentralPubMedCrossRefGoogle Scholar
  3. 3.
    Flegal KM, Wei R, Ogden C (2002) Weight-for-stature compared with body mass index-for-age growth charts for the United States from the Centers for Disease Control and Prevention. Am J Clin Nutr 75(4):761–766PubMedGoogle Scholar
  4. 4.
    Himes JH, Dietz WH (1994) Guidelines for overweight in adolescent preventive services-recommendations from an expert committee. Am J Clin Nutr 59(2):307–316PubMedGoogle Scholar
  5. 5.
    Flodmark CE, Lissau I, Moreno LA et al (2004) New insights into the field of children and adolescents’ obesity: the European perspective. Int J Obes 28(10):1189–1196CrossRefGoogle Scholar
  6. 6.
    Lazarus R, Baur L, Webb K, Blyth F (1996) Body mass index in screening for adiposity in children and adolescents: systematic evaluation using receiver operating characteristic curves. Am J Clin Nutr 63(4):500–506PubMedGoogle Scholar
  7. 7.
    Zhao Y, Lv G (2013) Correlation of C-reactive protein level and obesity in Chinese adults and children: a meta-analysis. J Endocrinol Invest 36(8):642–647PubMedGoogle Scholar
  8. 8.
    Danford LC, Schoeller DA, Kushner RF (1992) Comparison of two bioelectrical impedance analysis models for total body water measurement in children. Ann Hum Biol 19(6):603–607PubMedCrossRefGoogle Scholar
  9. 9.
    Deurenberg P, Van der Kooy K, Paling A, Withagen P (1989) Assessment of body composition in 8–11 year old children by bioelectrical impedance. Eur J Clin Nutr 43(9):623–629PubMedGoogle Scholar
  10. 10.
    Deurenberg P, Kusters CS, Smit HE (1990) Assessment of body composition by bioelectrical impedance in children and young adults is strongly age-dependent. Eur J Clin Nutr 44(4):261–268PubMedGoogle Scholar
  11. 11.
    Deurenberg P, Pieters JJ, Hautvast JG (1990) The assessment of the body fat percentage by skinfold thickness measurements in childhood and young adolescence. Br J Nutr 63(2):293–303PubMedCrossRefGoogle Scholar
  12. 12.
    Phillips SM, Bandini LG, Compton DV et al (2003) A longitudinal comparison of body composition by total body water and bioelectrical impedance in adolescent girls. J Nutr 133(5):1419–1425PubMedGoogle Scholar
  13. 13.
    Stevens J (1995) Obesity, fat patterning and cardiovascular risk. Adv Exp Med Biol 369:21–27PubMedCrossRefGoogle Scholar
  14. 14.
    Parsons TJ, Power C, Logan S, Summerbell CD (1999) Childhood predictors of adult obesity: a systematic review. Int J Obes Relat Metab Disord 23(Suppl 8):S1–S107PubMedGoogle Scholar
  15. 15.
    Whitaker RC, Wright JA, Pepe MS et al (1997) Predicting obesity in young adulthood from childhood and parental obesity. N Engl J Med 337(13):869–873PubMedCrossRefGoogle Scholar
  16. 16.
    Livingstone MB (2001) Childhood obesity in Europe: a growing concern. Public Health Nutr 4(1A):109–116PubMedCrossRefGoogle Scholar
  17. 17.
    James PT (2004) Obesity: the worldwide epidemic. Clin Dermatol 22(4):276–280PubMedCrossRefGoogle Scholar
  18. 18.
    Kelishadi R, Pour MH, Sarraf-Zadegan N et al (2003) Obesity and associated modifiable environmental factors in Iranian adolescents: Isfahan healthy heart program—heart health promotion from childhood. Pediatr Int 45(4):435–442PubMedCrossRefGoogle Scholar
  19. 19.
    AlNuaim AR, Bamgboye EA, AlHerbish A (1996) The pattern of growth and obesity in Saudi Arabian male school children. Int J Obes Relat Metab Disord 20(11):1000–1005Google Scholar
  20. 20.
    McCarthy HD, Ellis SM, Cole TJ (2003) Central overweight and obesity in British youth aged 11–16 years: cross sectional surveys of waist circumference. BMJ 326(7390):624PubMedCentralPubMedCrossRefGoogle Scholar
  21. 21.
    Ruxton CH, Reilly JJ, Kirk TR (1999) Body composition of healthy 7- and 8-year-old children and a comparison with the ‘reference child’. Int J Obes Relat Metab Disord 23(12):1276–1281PubMedCrossRefGoogle Scholar
  22. 22.
    Oken E, Gillman MW (2003) Fetal origins of obesity. Obes Res 11(4):496–506PubMedCrossRefGoogle Scholar
  23. 23.
    Ong KK, Ahmed ML, Emmett PM et al (2000) Association between postnatal catch-up growth and obesity in childhood: prospective cohort study. BMJ 320(7240):967–971PubMedCentralPubMedCrossRefGoogle Scholar
  24. 24.
    Morrison JL, Duffield JA, Muhlhausler BS et al (2010) Fetal growth restriction, catch-up growth and the early origins of insulin resistance and visceral obesity. Pediatr Nephrol 25(4):669–677PubMedCrossRefGoogle Scholar
  25. 25.
    Kensara OA, Wootton SA, Phillips DI et al (2005) Fetal programming of body composition: relation between birth weight and body composition measured with dual-energy X-ray absorptiometry and anthropometric methods in older Englishmen. Am J Clin Nutr 82(5):980–987PubMedGoogle Scholar
  26. 26.
    Gale CR, Martyn CN, Kellingray S et al (2001) Intrauterine programming of adult body composition. J Clin Endocrinol Metab 86(1):267–272PubMedGoogle Scholar
  27. 27.
    Corvalan C, Gregory CO, Ramirez-Zea M et al (2007) Size at birth, infant, early and later childhood growth and adult body composition: a prospective study in a stunted population. Int J Epidemiol 36(3):550–557PubMedCrossRefGoogle Scholar
  28. 28.
    Sachdev HS, Fall CH, Osmond C et al (2005) Anthropometric indicators of body composition in young adults: relation to size at birth and serial measurements of body mass index in childhood in the New Delhi birth cohort. Am J Clin Nutr 82(2):456–466PubMedGoogle Scholar
  29. 29.
    Li H, Stein AD, Barnhart HX et al (2003) Associations between prenatal and postnatal growth and adult body size and composition. Am J Clin Nutr 77(6):1498–1505PubMedGoogle Scholar
  30. 30.
    Victora CG, Sibbritt D, Horta BL et al (2007) Weight gain in childhood and body composition at 18 years of age in Brazilian males. Acta Paediatr 96(2):296–300PubMedCentralPubMedCrossRefGoogle Scholar
  31. 31.
    Kuzawa CW, Hallal PC, Adair L et al (2012) Birth weight, postnatal weight gain, and adult body composition in five low and middle income countries. Am J Hum Biol 24(1):5–13PubMedCentralPubMedCrossRefGoogle Scholar
  32. 32.
    Stein AD, Kahn HS, Rundle A et al (2007) Anthropometric measures in middle age after exposure to famine during gestation: evidence from the Dutch famine. Am J Clin Nutr 85(3):869–876PubMedGoogle Scholar
  33. 33.
    Ravelli AC, Van Der Meulen JH, Osmond C et al (1999) Obesity at the age of 50 y in men and women exposed to famine prenatally. Am J Clin Nutr 70(5):811–816PubMedGoogle Scholar
  34. 34.
    Stein AD, Rundle A, Wada N et al (2009) Associations of gestational exposure to famine with energy balance and macronutrient density of the diet at age 58 years differ according to the reference population used. J Nutr 139(8):1555–1561PubMedCentralPubMedCrossRefGoogle Scholar
  35. 35.
    Dewey KG (2003) Is breastfeeding protective against child obesity? J Hum Lact 19(1):9–18PubMedCrossRefGoogle Scholar
  36. 36.
    Arenz S, Ruckerl R, Koletzko B, Von Kries R (2004) Breast-feeding and childhood obesity—a systematic review. Int J Obes Relat Metab Disord 28(10):1247–1256PubMedCrossRefGoogle Scholar
  37. 37.
    Harder T, Bergmann R, Kallischnigg G, Plagemann A (2005) Duration of breastfeeding and risk of overweight: a meta-analysis. Am J Epidemiol 162(5):397–403PubMedCrossRefGoogle Scholar
  38. 38.
    Horta BL, Bahl R, Martines JC, Victora CG (2007) Evidence on the Long-Term Effects of Breastfeeding: Systematic Review and Meta-Analyses.
  39. 39.
    Owen CG, Martin RM, Whincup PH et al (2005) The effect of breastfeeding on mean body mass index throughout life: a quantitative review of published and unpublished observational evidence. Am J Clin Nutr 82(6):1298–1307PubMedGoogle Scholar
  40. 40.
    Hediger ML, Overpeck MD, Kuczmarski RJ, Ruan WJ (2001) Association between infant breastfeeding and overweight in young children. JAMA 285(19):2453–2460PubMedCrossRefGoogle Scholar
  41. 41.
    Baker JL, Michaelsen KF, Rasmussen KM, Sorensen TI (2004) Maternal prepregnant body mass index, duration of breastfeeding, and timing of complementary food introduction are associated with infant weight gain. Am J Clin Nutr 80(6):1579–1588PubMedGoogle Scholar
  42. 42.
    Khambalia AZ, Dickinson S, Hardy LL et al (2012) A synthesis of existing systematic reviews and meta-analyses of school-based behavioural interventions for controlling and preventing obesity. Obes Rev 13(3):214–233PubMedCrossRefGoogle Scholar
  43. 43.
    Llargues E, Franco R, Recasens A et al (2011) Assessment of a school-based intervention in eating habits and physical activity in school children: the AVall study. J Epidemiol Community Health 65(10):896–901PubMedCentralPubMedCrossRefGoogle Scholar
  44. 44.
    Cizza G, Rother KI (2012) Beyond fast food and slow motion: weighty contributors to the obesity epidemic. J Endocrinol Invest 35(2):236–242PubMedCentralPubMedGoogle Scholar
  45. 45.
    Kipping RR, Payne C, Lawlor DA (2008) Randomised controlled trial adapting US school obesity prevention to England. Arch Dis Child 93(6):469–473PubMedCrossRefGoogle Scholar
  46. 46.
    Marcus C, Nyberg G, Nordenfelt A et al (2009) A 4-year, cluster-randomized, controlled childhood obesity prevention study: STOPP. Int J Obes 33(4):408–417CrossRefGoogle Scholar
  47. 47.
    Luepker RV, Perry CL, McKinlay SM et al (1996) Outcomes of a field trial to improve children’s dietary patterns and physical activity. The child and adolescent trial for cardiovascular health. CATCH collaborative group. JAMA 275(10):768–776PubMedCrossRefGoogle Scholar
  48. 48.
    Trevino RP, Yin Z, Hernandez A et al (2004) Impact of the Bienestar school-based diabetes mellitus prevention program on fasting capillary glucose a randomized controlled trial. Arch Pediatr Adolesc Med 158(9):911–917PubMedCentralPubMedCrossRefGoogle Scholar
  49. 49.
    Salcedo Aguilar F, Martínez-Vizcaíno V, Sánchez López M et al (2010) Impact of an after-school physical activity program on obesity in children. J Pediatr 157(1):36–42PubMedCrossRefGoogle Scholar
  50. 50.
    Donnelly JE, Greene JL, Gibson CA et al (2009) Physical Activity Across the Curriculum (PAAC): a randomized controlled trial to promote physical activity and diminish overweight and obesity in elementary school children. Prev Med 49(4):336–341PubMedCentralPubMedCrossRefGoogle Scholar
  51. 51.
    Sichieri R, Paula Trotte A, de Souza RA, Veiga GV (2009) School randomised trial on prevention of excessive weight gain by discouraging students from drinking sodas. Public Health Nutr 12(2):197–202PubMedCrossRefGoogle Scholar
  52. 52.
    Johnston CA, Moreno JP, El-Mubasher A et al (2013) Impact of a school-based pediatric obesity prevention program facilitated by health professionals. J Sch Health 83(3):171–181PubMedCrossRefGoogle Scholar
  53. 53.
    Wright K, Norris K, Newman Giger J, Suro Z (2012) Improving healthy dietary behaviours, nutrition knowledge, and self-efficacy among underserved school children with parent and community involvement. Child Obes 8(4):347–356PubMedGoogle Scholar
  54. 54.
    Magnusson KT, Hannes Hrafnkelsson H, Sigurgeirsson I et al (2012) Limited effects of a 2-year school-based physical activity intervention on body composition and cardiorespiratory fitness in 7-year-old children. Health Educ Res 27(3):484–494PubMedCrossRefGoogle Scholar
  55. 55.
    Williamson DA, Champagne CM, Harsha D et al (2012) Effect of an environmental school-based obesity prevention program on changes in body fat and body weight: a randomized trial. Obesity 20(8):1653–1661PubMedCentralPubMedCrossRefGoogle Scholar
  56. 56.
    Crespo NC, Elder JP, Ayala GX et al (2012) Results of a multi-level intervention to prevent and control childhood obesity among Latino children: the Aventuras Para Niños Study. Ann Behav Med 43(1):84–100PubMedCentralPubMedCrossRefGoogle Scholar
  57. 57.
    Rush E, Reed P, McLennan S et al (2012) A school-based obesity control programme: project Energize. Two-year outcomes. Br J Nutr 107(4):581–587PubMedCrossRefGoogle Scholar
  58. 58.
    Jansen W, Borsboom G, Meima A et al (2011) Effectiveness of a primary school-based intervention to reduce overweight. Int J Pediatr Obes 6(2–2):70–77CrossRefGoogle Scholar
  59. 59.
    Thivel D, Isacco L, Lazaar N et al (2011) Effect of a 6-month school-based physical activity program on body composition and physical fitness in lean and obese schoolchildren. Eur J Pediatr 170(11):1435–1443PubMedCrossRefGoogle Scholar
  60. 60.
    Greening L, Harrell KT, Low AK, Fielder CE (2011) Efficacy of a school-based childhood obesity intervention program in a rural southern community: TEAM Mississippi Project. Obesity 19(6):1213–1219PubMedCrossRefGoogle Scholar
  61. 61.
    Kriemler S, Zahner L, Schindler C et al (2010) Effect of school based physical activity programme (KISS) on fitness and adiposity in primary schoolchildren: cluster randomised controlled trial. BMJ 340:c785PubMedCentralPubMedCrossRefGoogle Scholar
  62. 62.
    Muckelbauer R, Libuda L, Clausen K et al (2009) Promotion and provision of drinking water in schools for overweight prevention: randomized controlled cluster trial. Pediatrics 123(4):661–667CrossRefGoogle Scholar
  63. 63.
    Graf C, Koch B, Falkowski G et al (2008) School-based prevention: effects on obesity and physical performance after 4 years. J Sports Sci 26(10):987–994PubMedCrossRefGoogle Scholar
  64. 64.
    Gentile DA, Welk G, Eisenmann JC et al (2009) Evaluation of a multiple ecological level child obesity prevention program: switch what you do, view, and chew. BMC Med 7:49PubMedCentralPubMedCrossRefGoogle Scholar
  65. 65.
    Foster GD, Sherman S, Borradaile KE et al (2008) A policy-based school intervention to prevent overweight and obesity. Pediatrics 121(4):794–802CrossRefGoogle Scholar
  66. 66.
    Plachta-Danielzik S, Pust S, Asbeck I et al (2007) Four-year follow-up of school-based intervention on overweight children: the KOPS study. Obesity 15(12):3159–3169PubMedCrossRefGoogle Scholar
  67. 67.
    Jiang J, Xia X, Greiner T et al (2007) The effects of a 3-year obesity intervention in schoolchildren in Beijing. Child Care Health Dev 33(5):641–646PubMedCrossRefGoogle Scholar
  68. 68.
    Williamson DA, Copeland AL, Anton SD et al (2007) Wise Mind project: a school-based environmental approach for preventing weight gain in children. Obesity 15(4):906–917PubMedCrossRefGoogle Scholar
  69. 69.
    Spiegel SA, Foulk D (2006) Reducing overweight through a multidisciplinary school-based intervention. Obesity 14(1):88–96PubMedCrossRefGoogle Scholar
  70. 70.
    Kafatos A, Manios Y, Moschandreas J (2005) Health and nutrition education in primary schools of Crete: follow-up changes in body mass index and overweight status. Eur J Clin Nutr 59(9):1090–1092PubMedCrossRefGoogle Scholar
  71. 71.
    Yin Z, Gutin B, Johnson MH et al (2005) An environmental approach to obesity prevention in children: medical College of Georgia FitKid Project year 1 results. Obes Res 13(12):2153–2161PubMedCrossRefGoogle Scholar
  72. 72.
    Salmon J, Ball K, Hume C et al (2008) Outcomes of a group-randomized trial to prevent excess weight gain, reduce screen behaviours and promote physical activity in 10-year-old children: switch-play. Int J Obes 32(4):601–612CrossRefGoogle Scholar
  73. 73.
    James J, Thomas P, Cavan D, Kerr D (2004) Preventing childhood obesity by reducing consumption of carbonated drinks: cluster randomised controlled trial. BMJ 328(7450):1237PubMedCentralPubMedCrossRefGoogle Scholar
  74. 74.
    Warren JM, Henry CJK, Lightowler HJ et al (2003) Evaluation of a pilot school programme aimed at the prevention of obesity in children. Health Promot Int 18(4):287–296PubMedCrossRefGoogle Scholar
  75. 75.
    Caballero B, Clay T, Davis SM et al (2003) Pathways: a school-based, randomized controlled trial for the prevention of obesity in American Indian schoolchildren. Am J Clin Nutr 78(5):1030–1038PubMedGoogle Scholar
  76. 76.
    Sahota P, Rudolf MC, Dixey R et al (2001) Randomised controlled trial of primary school based intervention to reduce risk factors for obesity. BMJ 323:1029–1032PubMedCentralPubMedCrossRefGoogle Scholar
  77. 77.
    Robinson TN (1999) Reducing children’s television viewing to prevent obesity: a randomized controlled trial. JAMA 282(16):1561–1567PubMedCrossRefGoogle Scholar
  78. 78.
    Vandongen R, Jenner DA, Thompson C et al (1995) A controlled evaluation of a fitness and nutrition intervention program on cardiovascular health in 10- to 12-year-old children. Prev Med 24(1):9–22PubMedCrossRefGoogle Scholar
  79. 79.
    Gonzalez-Suarez C, Worley A, Grimmer-Somers K, Dones V (2009) School-based interventions on childhood obesity a meta-analysis. Am J Prev Med 37(5):418–427PubMedCrossRefGoogle Scholar
  80. 80.
    Zenzen W, Kridli S (2009) Integrative review of school-based childhood obesity prevention programs. J Pediatr Health Care 23(4):242–258PubMedCrossRefGoogle Scholar
  81. 81.
    Brown T, Summerbell C (2009) Systematic review of school-based interventions that focus on changing dietary intake and physical activity levels to prevent childhood obesity: an update to the obesity guidance produced by the National Institute for Health and Clinical Excellence. Obes Rev 10(1):110–141PubMedCrossRefGoogle Scholar
  82. 82.
    Nguyen B, Kornman KP, Baur LA (2011) A review of electronic interventions for prevention and treatment of overweight and obesity in young people. Obes Rev 12(5):298–314CrossRefGoogle Scholar
  83. 83.
    Li JS, Barnett TA, Goodman E, Wasserman RC, Kemper AR, American Heart Association Atherosclerosis, Hypertension and Obesity in the Young Committee of the Council on Cardiovascular Disease in the Young, Council on Epidemiology and Prevention, and Council on Nutrition, Physical Activity and Metabolism (2013) Approaches to the prevention and management of childhood obesity: the role of social networks and the use of social media and related electronic technologies: a scientific statement from the American Heart Association. Circulation 127(2):260–267PubMedCrossRefGoogle Scholar
  84. 84.
    Hamel LM, Robbins LB (2013) Computer- and web-based interventions to promote healthy eating among children and adolescents: a systematic review. J Adv Nurs 69(1):16–30PubMedCrossRefGoogle Scholar
  85. 85.
    Gabriele JM, Stewart TM, Sample A et al (2010) Development of an internet-based obesity prevention program for children. J Diabetes Sci Technol 4(3):723–732PubMedCentralPubMedCrossRefGoogle Scholar
  86. 86.
    Thompson D, Baranowski T, Cullen K et al (2008) Food, fun and fitness internet program for girls: influencing log-on rate. Health Educ Res 23(2):228–237PubMedCrossRefGoogle Scholar
  87. 87.
    Thompson D, Baranowski T, Cullen K et al (2008) Food, fun, and fitness internet program for girls: pilot evaluation of an e-health youth obesity prevention program examining predictors of obesity. Prev Med 47(5):494–497PubMedCrossRefGoogle Scholar
  88. 88.
    Southard DR, Southard BH (2006) Promoting physical activity in children with MetaKenkoh. Clin Invest Med 29(5):293–297PubMedGoogle Scholar
  89. 89.
    Baranowski T, Baranowski JC, Cullen KW et al (2003) The Fun, Food, and Fitness Project (FFFP): the Baylor GEMS pilot study. Ethn Dis 13(1 Suppl 1):S30–S39PubMedGoogle Scholar

Copyright information

© Italian Society of Endocrinology (SIE) 2014

Authors and Affiliations

  • A. Verrotti
    • 1
    Email author
  • L. Penta
    • 1
  • L. Zenzeri
    • 1
  • S. Agostinelli
    • 2
  • P. De Feo
    • 3
    • 4
  1. 1.Department of PediatricsUniversity of PerugiaPerugiaItaly
  2. 2.Department of PediatricsMadonna del Soccorso HospitalTrontoItaly
  3. 3.Department of Internal MedicineUniversity of PerugiaPerugiaItaly
  4. 4.CURIAMO CenterUniversity of PerugiaPerugiaItaly

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